Tag: Medicine

You see them stroll around in the hospitals’ toughest wards with their red noses, colorful clothes, and unwavering smiles, spreading laughter and cheerfulness wherever they go. They are the medical clowns: trained professionals whose goal is to change the hospital environment through humor. 

A new study tested and categorized the skills of medical clowns and found that their importance goes far beyond contributing to a patient’s good mood. The researchers identified 40 different skills of medical clowns, including establishing an emotional connection and creating a personal relationship with the patient, expressing the patient’s frustrations and difficulties to the medical staff, increasing the patient’s motivation to adhere to medical treatment, distracting the patient from pain, and creating a joyful atmosphere.

Medical clowns working alongside other therapists (Photo: The Dream Doctors Project, Medical Clowning in Action)

Not Just for Entertainment Purposes

The research was conducted under the leadership of Prof. Orit Karnieli-Miller, with Dr. Lior Rosenthal, both from the Department of Medical Education at TAU’s Sackler Faculty of Medicine, in collaboration with Ms. Orna Divon-Ophir, Dr. Doron Sagi, Prof. Amitai Ziv and Ms. Liat Pessach-Gelblum from the Israel Center for Medical Simulation (MSR). The study was published in Qualitative Health Research, a leading journal in the field of health.

The researchers show that not only do medical clowns help the patients and their family members, but also the medical team and the achievement of treatment goals.

Through use of different communication skills, clowns make it easier for the patient to cooperate with various treatments. The medical clowns work in a team with other therapists, know how to intervene and help whenever an argument or crisis should arise to advance treatment.

“From the moment they enter the room, the clowns form a bond with the patients, strengthen them, and give them power and status within the medical system.” Prof. Orit Karnieli-Miller. 

Decoding their “Secret Magic”

Studies conducted throughout the years have shown the clowns’ positive influence on the hospital environment through humor, as well as helping patients deal with pain. However, no studies have empirically mapped the skills they use and their therapeutic goals to help understand their “secret magic.” In addition, there was a lack of broad understanding of how clowns can help children, teenagers, and their parents in various challenging situations of distress and difficulty, as well as how they can help patients and medical teams achieve treatment goals. This lack of appreciation of the potential benefits of utilizing the services of medical clowns meant that patients and medical teams would occasionally be reluctant to cooperate with them.

As part of the new study, the researchers focused on qualitative, in-depth systematic identification of the skills of medical clowns through observation and analysis of their actions in challenging encounters with adolescents, parents, and medical staff.

Medical clowns help patients and medical teams achieve treatment goals (Photo: The Dream Doctors Project, Medical Clowning in Action)

The team analyzed videotaped sessions of medical clowns in various simulated situations and conducted in-depth interviews with expert medical clowns. The researchers identified 40 different skills used by the medical clowns to achieve four therapeutic goals:

1) building a relationship and connecting to the needs and desires of the patients

2) dealing with emotions and difficulties

3) increasing the patient’s motivation to adhere to the treatment plan

4) increasing the patient’s sense of control and providing encouragement to patients

The clowns examined in the study were trained and recruited by the “Dream Doctors Project”, a non-profit association that employs medical clowns as part of the paramedical system in Israeli hospitals, and trains them to work within multi-disciplinary teams. The Tel Aviv University researchers collaborated with the Israel Center for Medical Simulation (MSR), which created a simulation-based workshop focused on developing the skills of experienced medical clowns.

“From the moment they enter the room, the clowns form a bond with the patients, strengthen them, and give them power and status within the medical system,” explains Prof. Karnieli-Miller. “They do this through an initial connection to the patients’ voice, and even to the patients’ reluctance to implement therapeutic recommendations – an emotional connection that often results in the patient changing their position and cooperating with the medical staff.”

Providing the patient with an increased sense of control and courage to face their challenges (Photo: The Dream Doctors Project, Medical Clowning in Action)

According to Prof. Karnieli-Miller the medical system is hierarchical, and it is not always easy for patients to navigate. Therefore, one of the skills of medical clowns is to place themselves in the lowest position in the medical setting. By doing so, they empower the patients by giving them a sense of power and control, including the choice of whether to allow the clown to enter the room as well as to dictate the nature of the patient’s role vis-à-vis that of the clown. This provides the patient with an increased sense of control and courage to face their challenges.

The researchers emphasize that the clowns are very aware of the emotional difficulty associated with staying in a hospital and dealing with an illness. To help deal with these issues, the clowns sometimes distract the patient by using props, humor, and imagination. Other skills include allowing the patient to direct their frustrations towards them, away from medical staff or parents.

Depending on the situation the clowns may also use a comforting touch, soothing music, empathetic listening, or a reinforcing statement to provide an environment where the patient feels comfortable to express their feelings. A patient’s ability to gain legitimacy is important and is strengthened by the clowns.

Prof. Orit Karnieli-Miller

“Mapping the skills and goals of the medical clowns improves their understanding of their role and may help other health professionals appreciate their work methods and the benefits of incorporating these methods into their own practices when faced with similar challenges” Prof. Orit Karnieli-Miller.

Learning from Medical Clowns’ Methods

“Mapping the skills and goals of the medical clowns improves their understanding of their role and may help other health professionals appreciate their work methods and the benefits of incorporating these methods into their own practices when faced with similar challenges,” adds Prof. Karnieli-Miller.

“This research is important because it allows the clowns to enhance their training program and refine their diverse skills to achieve the various therapeutic goals appropriate for different patients, as well as helping health professionals collaborate with the medical clowns. If professionals in the healthcare field gain a clear understanding of how and when to cooperate with the medical clowns, they will be able to help patients overcome challenges, and at the same time they may be more tolerant of the clowns’ ‘disruption’ of the hospital care regimen. This appreciation of the clowns’ contribution will provide the clowns with the time and space to connect with patients and help and encourage patients to become more active participants in their treatment plan,” she concludes.

A new preliminary study from Tel Aviv University reveals that due to masculine dominance of the gynecological science field, most gynecological research focuses on childbirth and reproduction rather than women’s health and wellbeing. Mapping scientific journals in the category of gynecology and obstetrics, the study found that the majority deal with fertility, pregnancy, fetuses, and childbirth, while many topics that are much more critical to women’s quality of life receive little attention, both in scientific research and in the clinic.

The study was conducted by Dr. Netta Avnoon of the Department of Sociology and Anthropology and the Coller School of Management at Tel Aviv University. The preliminary results were published in the prestigious journal Nature Reviews Urology

“Men have dominated gynecology for almost a thousand years, and their gender identity impacts everything that happens in this specialty, including research design and medical practices.” Dr Netta Avnoon

Male Dominated Discipline

According to the preliminary study important issues that have been marginalized for centuries include diseases and damage to the muscles and nerves of the female pelvis and sexual organs, female sexual pleasure, rights and autonomy in childbirth, the connection between the menstrual cycle and the immune system, menopause, and the later years of life, and more.

“Men have dominated gynecology for almost a thousand years, and their gender identity impacts everything that happens in this specialty, including research design and medical practices,” says Dr. Avnoon. “Even if they are unaware of their own bias and have the best intentions, men traditionally regard the female body as an object for producing babies or satisfying men’s sexual desires. The time has come for women to dominate the discipline that is meant to care for their health.”

Dr. Avnoon explains that no social activity is neutral, objective or contextless, and science and medicine are no exception. Inevitably, social positions and dispositions impact the attitudes of those who create science.

Extensive historical and feminist scholarship has shown that gynecology as a medical specialty was masculinized 800 years ago, and still adheres to patriarchal values. In ancient times women were usually treated by women-experts, who even wrote books on the subject, but during the Middle Ages, these women and their knowledge were gradually ousted and replaced by men.

Since the 16th century the specialty has been wholly dominated by males, and consequently they were the ones to determine which topics are ‘interesting’ and worth studying; they were the ones who set practices and protocols and introduced treatments, technologies, and techniques, all too often subjecting patients to medical practices that are not necessarily benevolent.

Dr. Netta Avnoon

Exposing Current Focus

To expose the actual focus of gynecological research today, in line with previous feminist studies, Dr. Avnoon chose a tell-tale indicator: the titles of international scientific journals in the ‘gynecology and obstetrics’ category.

She analyzed the list appearing in the Journal Citation Reports, a database that provides general and statistical information about scientific journals worldwide, and the results were clear-cut: of the 83 journals listed by title in the category, 49% are dedicated solely to reproductive functions, pregnancy, fetuses, and childbirth; 24% focus on both gynecology and obstetrics; only 12% deal with health issues in the female sexual organs that are unrelated to reproductive functions; 6% deal with breasts; 5% deal with gynecological cancers; and a mere 4% (3 journals) address the health of women before and after childbearing age, including menopause.

Dr. Avnoon notes a recent instance of gynecology’s gender bias: the transvaginal mesh scandal. In 2019 the FDA banned the use of the transvaginal mesh – a common gynecological procedure used since the 1950s to repair pelvis organ prolapse in the anterior vaginal compartment, which had caused extensive morbidity and even 77 documented deaths in the USA.

Patients’ activism moved the regulator to intervene, exposing the decades-long failure of gynecological science to clinically assess the outcomes of this surgical procedure, and revealing the bias in how researchers presented these results in scientific publications.

“Care for the fetus, essential in its own right, must not come at the expense of the mother’s health.” Dr. Netta Avnoon

It’s Time: Women-Centered Gynecology

What solution does Dr. Avnoon have in mind? She proposes the following: “Obstetrics, focusing on fertility, reproduction, pregnancy, the fetus and childbirth, should be separated from gynecology, a specialty dedicated to women’s health.”

“Care for the fetus, essential in its own right, must not come at the expense of the mother’s health.”

“Also, gynecology training must include a major chapter of gender and feminist studies, and existing medical protocols should be amended to focus on the needs of the women – rather than those of their babies, their spouses, or their doctors. Moreover, legislation and legal procedures are in order, especially in courts of human rights, to protect women’s right to health and optimal medical care.”

“The time has come for women-centered gynecology,” says Dr. Avnoon. “Women’s voices must be heard.”

“To date, medical schools offer their students very scant and unsatisfactory knowledge about female anatomy and physiology, specifically in terms of women’s sexuality. Even though the overall numbers of female gynecologists are on the rise (in the US there are by now more women than men in this profession), their education is still based on age-old masculine and chauvinistic traditions.”

“In order to generate real change, doctors must be trained to regard women’s rights, health, and sexuality as the focus of women’s medicine, and to treat their patients with respect. Greater emphasis should be given to patient experience and autonomy in medical settings, and to much-needed innovation in research, instruments, technologies, protocols, surgical procedures, and medications.”

A new technology developed at Tel Aviv University makes it possible to destroy cancerous tumors in a targeted manner, via a combination of ultrasound and the injection of nanobubbles into the bloodstream. Unlike invasive treatment methods or the injection of microbubbles into the tumor itself, this latest technology enables the destruction of the tumor in a non-invasive manner.

The study was conducted under the leadership of doctoral student Mike Bismuth from the lab of Dr. Tali Ilovitsh at Tel Aviv University’s Department of Biomedical Engineering, in collaboration with Dr. Dov Hershkovitz of the Department of Pathology. Prof. Agata Exner from Case Western Reserve University in Cleveland also participated in the study. The study was published in the journal Nanoscale.

“Our new technology makes it possible, in a relatively simple way, to inject nanobubbles into the bloodstream, which then congregate around ​​the cancerous tumor. After that, using a low-frequency ultrasound, we explode the nanobubbles, and thereby the tumor.”  Dr. Tali Ilovitsh

Bursting Bubbles – and Tumors

Dr. Tali Ilovitsh: “Our new technology makes it possible, in a relatively simple way, to inject nanobubbles into the bloodstream, which then congregate around ​​the cancerous tumor. After that, using a low-frequency ultrasound, we explode the nanobubbles, and thereby the tumor.”

The researchers explain that today, the prevalent method of cancer treatment is surgical removal of the tumor, in combination with complementary treatments such as chemotherapy and immunotherapy.

The research team

Therapeutic ultrasound to destroy the cancerous tumor is a non-invasive alternative to surgery. This method has both advantages and disadvantages. On the one hand, it allows for localized and focused treatment; the use of high-intensity ultrasound can produce thermal or mechanical effects by delivering powerful acoustic energy to a focal point with high spatial-temporal precision. This method has been used to effectively treat solid tumors deep within in the body. Moreover, it makes it possible to treat patients who are unfit for tumor resection surgery. The disadvantage, however, is that the heat and high intensity of the ultrasound waves may damage the tissues near the tumor.

“The combination of nanobubbles and low frequency ultrasound waves provides a more specific targeting of the area of the tumor and reduces off-target toxicity.” Dr. Tali Ilovitsh

Reducing Off-target Damage

In the current study, Dr. Ilovitsh and her team sought to overcome this problem. In the experiment, which used an animal model, the researchers were able to destroy the tumor by injecting nanobubbles into the bloodstream (as opposed to what has been until now, which is the local injection of microbubbles into the tumor itself), in combination with low-frequency ultrasound waves, with minimal off-target effects.

“The combination of nanobubbles and low frequency ultrasound waves provides a more specific targeting of the area of the tumor, and reduces off-target toxicity,” explains Dr. Ilovitsh.

“Applying the low frequency to the nanobubbles causes their extreme swelling and explosion, even at low pressures. This makes it possible to perform the mechanical destruction of the tumors at low-pressure thresholds.”

“Our method has the advantages of ultrasound, in that it is safe, cost-effective, and clinically available, and in addition, the use of nanobubbles facilitates the targeting of tumors because they can be observed with the help of ultrasound imaging.”

Dr. Ilovitsh adds that the use of low-frequency ultrasound also increases the depth of penetration, minimizes distortion and attenuation, and enlarges the focal point. “This can help in the treatment of tumors that are located deep with the body, and in addition facilitate the treatment of larger tumor volumes. The experiment was conducted in a breast cancer tumor lab model, but it is likely that the treatment will also be effective with other types of tumors, and in the future, also in humans.”

A new study at Tel Aviv University found that aerobic exercise can reduce the risk of metastatic cancer by 72%. According to the researchers, intensity aerobic exercise increases the glucose (sugar) consumption of internal organs, thereby reducing the availability of energy to the tumor.  

The study was led by two researchers from TAU’s Sackler Faculty of Medicine: Prof. Carmit Levy from the Department of Human Molecular Genetics and Biochemistry and Dr. Yftach Gepner from the School of Public Health and the Sylvan Adams Sports Institute. The paper was published in the prestigious journal Cancer Research and chosen for the cover of the November 2022 issue

“If the general message to the public so far has been ‘be active, be healthy’, now we can explain how aerobic activity can maximize the prevention of the most aggressive and metastatic types of cancer.” Prof. Carmit Levy and Dr. Ytach Gepner

Enhanced Rate of Glucose Consumption

Previous studies have demonstrated that physical exercise reduces the risk for some types of cancer by up to 35%. This positive effect resembles the impact of exercise on other conditions, such as heart disease and diabetes.

In this study, Prof. Levy and Dr. Gepner added new insight, showing that high-intensity aerobic exercise, which derives its energy from sugar, can reduce the risk of metastatic cancer by as much as 72%. “If the general message to the public so far has been ‘be active, be healthy’,” they say, “now we can explain how aerobic activity can maximize the prevention of the most aggressive and metastatic types of cancer.”

The study combined lab models trained under a strict exercise regimen, with data from healthy human volunteers examined before and after running. The human data, obtained from an epidemiological study that monitored 3,000 individuals for about 20 years, indicated 72% less metastatic cancer in participants who reported regular aerobic activity at high intensity, compared to those who did not engage in physical exercise.

The animal model exhibited a similar outcome, enabling the researchers to identify its underlying mechanism. They found that aerobic activity significantly reduced the development of metastatic tumors in the lab models’ lymph nodes, lungs, and liver. The researchers hypothesized that in both humans and model animals, this favorable outcome is related to the enhanced rate of glucose consumption induced by exercise.

“Physical exercise, with its unique metabolic and physiological effects, exhibits a higher level of cancer prevention than any medication or medical intervention to date.” Dr. Yftach Gepner

From left to right: Prof. Carmit Levy and Dr. Yftach Gepner

“Exercise Changes the Whole Body”

“Our study is the first to investigate the impact of exercise on the internal organs in which metastases usually develop, like the lungs, liver, and lymph nodes,” explains Prof. Levy.

“Examining the cells of these organs, we found a rise in the number of glucose receptors during high-intensity aerobic activity – increasing glucose intake and turning the organs into effective energy-consumption machines, very much like the muscles. We assume that this happens because the organs must compete for sugar resources with the muscles, known to burn large quantities of glucose during physical exercise. Consequently, if cancer develops, the fierce competition over glucose reduces the availability of energy that is critical to metastasis.”

“Moreover,” she offers, “when a person exercises regularly, this condition becomes permanent: the tissues of internal organs change and become similar to muscle tissue. We all know that sports and physical exercise are good for our health. Our study, examining the internal organs, discovered that exercise changes the whole body, so that the cancer cannot spread, and the primary tumor also shrinks in size.”  

Prof. Levy emphasizes that by combining scientific knowhow from different schools at TAU, the new study has led to a very important discovery which may help prevent metastatic cancer – the leading cause of death in Israel.

“Our results indicate that unlike fat-burning exercise, which is relatively moderate, it is a high-intensity aerobic activity that helps in cancer prevention,” adds Dr. Gepner. “If the optimal intensity range for burning fat is 65-70% of the maximum pulse rate, sugar burning requires 80-85% – even if only for brief intervals.”

“For example: a one-minute sprint followed by walking, then another sprint. In the past, such intervals were mostly typical of athletes’ training regimens, but today we also see them in other exercise routines, such as heart and lung rehabilitation. Our results suggest that healthy individuals should also include high-intensity components in their fitness programs. We believe that future studies will enable personalized medicine for preventing specific cancers, with physicians reviewing family histories to recommend the right kind of physical activity. It must be emphasized that physical exercise, with its unique metabolic and physiological effects, exhibits a higher level of cancer prevention than any medication or medical intervention to date.”